Editor’s Note: Ready or not – and like it or not! — the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA) are scheduled for merger in less than 18 months. Points contributing editor Ron Roizen offers a two-part post on the history of the two institutes, the recent push toward merger, and the merger’s possible effects. This signal change in the organization of federally funded alcohol and drug research in the U.S. compels the attention of readers from across Points’ spectrum of history, policy, and advocacy. In addition to welcoming comments, we invite research and policy professionals with an interest in post-length comments on the merger– or on Roizen’s take on the merger– to contact Managing Editor Trysh Travis (firstname.lastname@example.org) to discuss future stints as guest bloggers.
Senator Harold Hughes
The planned decommissioning of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA) and the creation of a new National Institutes of Health (NIH) institute to take their places, now scheduled for launch in October, 2013 (FY2014), are notable developments in the history of the federal role in the application of science to alcohol- and drug-related public problems in the U.S. The push for merger of these two formerly separate public problem domains is by no means new. Sociologist David J. Pittman published an article titled, “The Rush To Combine: Sociological Dissimilarities of Alcoholism and Drug Abuse,” nearly a half-century ago, criticizing what he regarded as the contemporary trend toward conflation.(1) Pittman’s 1967 article appeared of course before either NIAAA, created in 1970, or NIDA, created in 1973, had arrived on the scene.
Despite their surface similarities, the two institutes grew out of quite different cultural and political circumstances. NIAAA’s creation was the product of a constituency-driven movement to modernize American attitudes toward alcoholism and, beyond that, to enhance the nation’s awareness of and substantially enlarge its response capacity with respect to a massive putative “hidden alcoholism” problem lurking unrecognized in our population.(2) The testimonies of Alcoholics Anonymous’s (AA) William Griffith Wilson,(3) National Council on Alcoholism’s (NCA) Mrs. Marty Mann, and actress Mercedes McCambridge highlighted the 1969 hearings of the Senate Special Subcommittee on Alcoholism and Narcotics, chaired by Senator Harold Hughes, which in turn lead to NIAAA’s creation.(4)
According to Nancy Olson’s account, R. Brinkley Smithers and Thomas P. Pike – the latter, an early member of AA, vice chair of the board of the Fluor Corporation, and an influential Republican who also offered testimony at the Hughes hearings – played key roles in convincing President Richard M. Nixon to sign the “Hughes Act” creating NIAAA, despite veto recommendations from some influential members of Nixon’s administration.(5) NIDA’s creation, in 1973, on the other hand, grew out of
In 1966, following a recommendation by the Cooperative Commission for the Study of Alcoholism, a National Center for Prevention and Treatment of Alcoholism was launched within the National Institute of Mental Health (NIMH). NIAAA’s subsequent creation in December, 1970, greatly expanded the federal investment in alcohol-related endeavors over that represented by the earlier NIMH center. Yet NIAAA, and later NIDA, would remain under NIMH’s organizational umbrella – with the associated tacit implication that alcoholism was properly classified as a mental illness – until the creation of the Alcohol, Drugs, and Mental Health Administration (ADAMHA) in 1973. With ADAMHA’s creation, NIAAA, NIDA, and NIMH became organizationally co-equal entities, though they remained unequal in terms of customary funding levels. The so-called “Gardner Report,”(11) which was instrumental in the creation of ADAMHA, recommended separate institutes for alcohol and drugs. The report’s authors, according to one account, “perceived a need for continued visibility and leadership, especially in the areas of drug abuse and alcohol abuse….”(12)
Carolyn L. Wiener’s sociological analysis of NIAAA’s institutional development stressed
Part 2 here.
Thanks are owed Kaye Fillmore, William L. White, and Loran Archer for comments on an earlier draft. I also thank Marc Schuckit for suggesting I should write something on the merger.
(1) David J. Pittman, British Journal of Addiction 62:337-343, 1967. Incidentally, I began a previous discussion of merger, prepared back in 1993, by making reference to the same Pittman paper (see http://www.roizen.com/ron/merger.htm).
(2) See, e.g., Gordon McKay Stevenson, Jr., “The Emergence of Non-Skid-Row Alcoholism as a ‘Public’ Problem,” Temple Law Quarterly 45(4):529-584, (Summer) 1972.
(3) Identified in the record only as “Bill W.” to preserve anonymity.
(4) Available online at: http://babel.hathitrust.org/cgi/pt?id=uc1.b4193168;page=root;view=image;size=100;seq=8;num=ii, accessed March 2, 2012
(5) Nancy Olson, With a Lot of Help from Our Friends: The Politics of Alcoholism, New York, Lincoln [NE], Shanghai: Writers Club Press, 2003, Kindle edition, slider at 1831-1840.
(6) See David F. Musto, “Drug abuse research in historical perspective,” Appendix B (pp. 284-294) in Committee on Opportunities in Drug Abuse Research, Division of Neuroscience and Behavioral Health, Institute of Medicine, Pathways of Addiction: Opportunities in Drug Abuse Research, Washington, D.C.: National Academy Press, 1996 and David T. Courtwright, “NIDA, This is Your Life,” Drug and Alcohol Dependence 107:116–118, 2010.
(7) Ron Roizen, “How does the nation’s ‘alcohol problem’ change from era to era? Stalking the social logic of problem-definition transformations since Repeal,” pp. 61-87 in Sarah Tracy and Caroline Acker (eds.), Altering the American Consciousness: Essays on the History of Alcohol and Drug Use in the United States, 1800-2000, Amherst: University of Massachusetts Press, 2004.
(8) Re Don Cahalan’s reluctant role in creating this estimate, see Deborah M. Barnes, “Drugs: Running the Numbers,” Science, New Series, Vol. 240, No. 4860 (Jun. 24, 1988), pp. 1729-1731.
(9) Nancy Olson, Ibid., Kindle edition, slider at 825-836, credits her own offhand remark to Senator Hughes as one source for a 13 million estimate at this time.
(10) On 18 million, see Joseph R. Gusfield, The Culture of Public Problems, Chicago: University of Chicago Press, 1981, p. 60. There is an interesting history of alcohol science paper to be written on how the then-contemporary preoccupation with prevalence estimation ultimately deflated. By 1980, sociologist Robin Room was suggesting that the number of high-problem-score alcoholics in the U.S. population was arguably roughly equivalent to the reported number of alcoholics already in some kind of treatment – or about one million (see Room, “Treatment-Seeking Populations and Larger Realities,” Ch. 13, pp. 205-224 in Griffith Edwards and Marcus Grant [eds.], Alcoholism Treatment in Transition, London: Croom Helm, 1980, see p. 212).
(11) E. A. Gardner, Final Report of the Mental Health Task Force (Washington D.C.: Department of Health and Human Services, 1973).
(12) Quoted in: Committee on Co-Administration of Service and Research Programs of the National Institutes of Health, the Alcohol, Drug Abuse, and Mental Health Administration, and Related Agencies, Institute of Medicine, Research and Service Programs in the PHS: Challenges in Organization, 1991, p. 32.
(13) Carolyn L. Wiener, The Politics of Alcoholism: Building an Arena Around a Social Problem, New Brunswick, NJ: Transaction, 1981.
(14) On the Laxalt episode, see Wiener, Ibid., pp. 142-143 and Olson, Ibid., Kindle edition, slider at 3859-3869.
(15) The Alcoholism Report, 5(5):2, December 24, 1976, p. 2.
(16) On the Klerman episode, see Olson, Ibid., Ch. 28, “The Klerman Controversies.”
(17) NIAAA and the other institutes’ initial review processes were eventually centralized in the 1990s when ADAMHA was abolished and the research functions of the three institutes were placed under the NIH umbrella.
(18) In Olson, Ibid., Kindle edition, slider at 3953.
(19) See Olson, Ibid., Kindle edition, slider at 3967.
(20) National Academy of Science, Enhancing the Vitality of the National Institutes of Health: Organizational Change to Meet New Challenges, Washington, D.C.: National Academies Press, 2003, p. 72.